According to the World Health Organization, a “maternal death” is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or the management, but not from accidental or incidental cause. Maternal mortality is not only related to the health-care provided by a country, but also to the country’s socio-economic and cultural aspects, in which women are usually at a great disadvantage.
Most maternal deaths are avoidable and should be avoided. This essay discusses the relation between high literacy rates and low mortality rates in different states in India. The Office of the Registrar General, India, under the Ministry of Home Affairs compiled a Special Bulletin on Maternal Mortality in India for the years 2007-2009 using the Sample Registration System (SRS). This Special Bulletin was published in June, 2011 and shows that the number of states that have realized the Millennium Development Goals (MDG) set by the United Nations have gone up three against one.
One of the main goals was to reduce the Maternal Mortality Rate to 200 maternal deaths per lakh of live births by the year 2007 and to 109 maternal deaths per lakh of live births by the year 2015. In order to understand the changes more appropriately, the states in India have been categorized into three main groups. The first group was called the “Empowered Action Group” (EAG) states consisting of Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Orissa, Rajasthan, Uttar Pradesh, Uttarakhand and Assam.
The second group consisted of the “Southern” states including Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. The third and final group consisted of “Other” states which included the remaining states and Union Territories. The Maternal Mortality Ratio is shown to have declined from 254 in 2004-2006 to 212 in 2007-2009. As per the data in the Special Bulletin, the Maternal Mortality Rate for each group of states is calculated by dividing the total Sample Female Population of each group by the total number of Maternal Deaths per group.
The survey shows that Maternal Mortality Rate in the EAG states is much higher than in the other two groups, with Assam having the lowest Maternal Mortality Rate within the group. Although there have been advancements in the health-care provided to mothers and new-borns, illiteracy and inaccessible health-care in the rural areas of our country (India), illiteracy and inadequate health-care are the main factors resulting in maternal deaths. Other factors are usually medical-related problems, which are also avoidable most of the time.
According to another survey conducted by Chryssa McAlister and Thomas F. Baskett which was published in their article “Female Education and Maternal Mortality”, statistics show that the Maternal Mortality Rate is higher in those countries in which the male population has a higher percentage of literacy and education. In this case, women who are not educated or literate tend to have low self-esteem and feel unconfident. This is because education and literacy is directly related to the status of a woman, her decision-making powers, her age at the time of marriage and most importantly, her ability to demand and access adequate medical health services.
In a Press Note released on 19 May 2010 by the Press Information Bureau on “Education in India 2007-2008: Participation and Expenditure” conducted by the National Sample Survey Organization, the states included in the “Empowered Action Group” (excluding Assam) are said to have a low literacy rate, whereas the states included in the “Southern” and “Other” groups are said to have a higher literacy and education percentage.
This information collaborates with the theory of McAlister and Baskett in saying that the Maternal Mortality Rate is lower in areas having a lower rate of literacy and education of the female population, as compared to the educated male population percentage. In conclusion, women who are uneducated or illiterate have been proven to be more prone to maternal mortality at the time of pregnancy due to lack of confidence, status and decision-making abilities. Therefore, states in our country which have high rates of maternal mortality should concentrate on educating their female population in order to reduce deaths at the time of child-birth.